Pseudomonas Aeruginosa Infection NCLEX Review Care Plans
Nursing Study Guide: Pseudomonas Aeruginosa Infection
Pseudomonas is a species of microorganisms known to dwell in soil and water sources. The most common type of Pseudomonas that causes infection in humans is Pseudomonas aeruginosa.
Pseudomonas is seen under the microscope as a gram negative, rod shaped monoflagellated bacterium which grows well at 25°C to 37°C, however, P. aeruginosa has an ability to grow at 42°C which helps distinguish it from many other Pseudomonas species.
Nursing Stat Facts
Signs and Symptoms of Pseudomonas Aeruginosa Infection
Pseudomonas aeruginosa is a versatile microorganism which can colonize multiple sites on the human body. Pseudomonas aeruginosa is considered an opportunistic infection and is commonly acquired as a hospital acquired infection. The sites it commonly attacks are the lungs, skin and urinary tract. Depending on the affected site, the symptoms observed may vary.
- Lungs – usually due to ventilator associated pneumonia
Pseudomonas aeruginosa colonizes a part of the ventilator system usually the tubes and will use the air as a vector for entry into the lungs. Common signs and symptoms associated with ventilator associated pneumonia are as follows:
- difficulty of breathing
- green tenacious sputum
2. Surgical site – usually due to breaks in sterile technique done during the surgery; may manifest as:
- redness around surgical site
- tenderness of the surgical site and the surrounding area
- leakage of pus usually greenish in color
- malodorous discharge with a fruity smell and greenish color
- green pus or discharge with a fruity smell
3. Urinary tract – usually acquired by way of catheter acquired UTI
Pseudomonas aeruginosa will colonize a portion of the catheter and use it as a port of entry into the urinary tract. The most common symptoms include:
- difficulty of voiding
- cloudy urine
4. Bloodstream – the bacteria may utilize central or peripheral venous access as its route of entry. septicemia may manifest as:
- fever and chills
- decreased urine output
- blotchy or discolored skin
- narrowed pulse pressure
- decreased blood pressure
- excessive sweating unrelated to ambient temperature
Causes and Risk Factors of Pseudomonas Aeruginosa Infection
As a microorganism, Pseudomonas aeruginosa has certain defining characteristics. One of these characteristics is a grape like fruity odor which is emitted from Pseudomonas aeruginosa colonies.
This odor is also present in wounds contaminated by Pseudomonas aeruginosa and can be utilized to increase suspicion for a possible Pseudomonas infection.
Wounds colonized by Pseudomonas Aeruginosa also tend to have a greenish discoloration of their secretions and surrounding area. The greenish discoloration is due to the presence of pigments pyocyanin and pyoverdine present in P. aeruginosa.
The route of spread for Pseudomonas aeruginosa is through direct contact of contaminated hands, surfaces or equipment.
Pseudomonas aeruginosa infections in humans are uncommon because the human immune response is usually sufficient to deal with these infections. However certain predisposing risk factors aide Pseudomonas in entering the human body and causing infection. These include patients:
- who are intubated and on mechanical ventilators
- with percutaneous insertions such as a urinary catheter and an intravenous cannula
- with extensive burns
- who are severely immunocompromised (e.g., aids patients, post-transplant recipients)
- patients who are in the postoperative period following major surgery
Complications of Pseudomonas Aeruginosa Infection
If left untreated, Pseudomonas aeruginosa can spread throughout the body and cause complications.
- Atelectasis. Overwhelming infection of the lung parenchyma can cause the collapse of the affected lung. This will subsequently cause hypoxia and death.
- Pleural effusion. Due to overwhelming infection, there is an increase of inflammatory mediators in the lungs which will attract fluid into the pleural space which will cause a pleural effusion.
- Meningitis. Migration of infectious emboli will lodge it into the external brain tissue and be caught in the blood brain barrier. The bacteria will multiply in the aforementioned space causing meningitis. This will manifest as fever, nuchal rigidity and seizures.
- Endocarditis. Migration of infectious foci thru the bloodstream will deliver the bacteria to the cardiac endocardium where they will multiply and cause inflammation resulting in endocarditis.
- Skin necrosis. Tissues on the skin, particularly those around the infected surgical wound site, can become necrotic due to extensive damage caused by the bacteria.
- Septicemia. P. aeruginosa can cause serious bloodstream infection.
Diagnosis of Pseudomonas Aeruginosa Infection
- Culture – the definitive diagnosis for Pseudomonas aeruginosa is through a bacterial culture from blood or secretions from the affected site whichever is more applicable. The sample may be grown in a blood agar, chocolate agar and MacConkey agar. The MacConkey agar is useful for isolating Pseudomonas aeruginosa from other contaminating microorganisms. Once developed, the colonies will be re-swabbed and placed under a microscope after staining to visualize it. Numerous tests for various enzymes will also be done to the culture to determine if the offending microorganism is indeed Pseudomonas aeruginosa. The colonies of Pseudomonas aeruginosa are usually round, greenish with a fruity odor and a shiny appearance owing to the presence of a capsule. The surrounding area shows hemolysis if grown in a plate of blood agar.
- Physical examination – presumptive diagnosis for Pseudomonas aeruginosa can be based on clinical criteria such as presence of a grapelike fruity odor of the wound, presence of Pseudomonas infections in the same hospital as the patient and the presence of greenish secretions around wound/burn site. Once presumptive diagnosis for P. aeruginosa is established, it is clinically warranted to start anti-pseudomonal treatment immediately after the drawing of blood for blood cultures.
Treatment for Pseudomonas Aeruginosa Infection
- Medication. Pseudomonas infections have a high rate of antibacterial resistance. Thus, they can be treated with specially formulated anti-pseudomonal beta lactams which are in the same drug class as penicillin. Beta lactams exert a bactericidal effect via osmotic damage thru the destruction of the bacterial cell wall. However, since Pseudomonas is a gram-negative bacterium, this drug is combined with either a fluoroquinolone or an aminoglycoside to achieve a bactericidal effect. However, routine culture and sensitivity testing is recommended as Pseudomonas aeruginosa has a high rate of antibiotic resistance, particularly for carbapenems.
- Isolation. To prevent the spread of P. aeruginosa infection between patients, the infected patient should be put on isolation, and the healthcare providers such as doctors and nurses should follow strict contact precautions, such as frequent handwashing and wearing gloves and gown.
- Sepsis protocol. Consider applying the hospital’s sepsis protocol, which usually includes administration of antibiotics and fluids, as well as strict input and output monitoring,
Prevention of Pseudomonas Aeruginosa Infection
There are preventive measures which can be done to prevent the spread of Pseudomonas aeruginosa. These include but are not limited to:
- Frequent hand washing before and after patient contact
- Frequent disinfection of all medical equipment
- Thorough sanitation of rooms and linens
- Frequent quality checks on water supplies to ensure they are not contaminated by Pseudomonas aeruginosa
- Sterilization of surgical equipment every after surgery
- Avoidance of any breaks in sterile surgical technique
Nursing Care Plans for Pseudomonas aeruginosa Infection
Nursing Care Plan 1
Nursing Diagnosis: Hyperthermia related to mechanical ventilator –related pneumonia secondary to Pseudomonas aeruginosa infection as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs that are administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat bacterial infection, which is the underlying cause of the patient’s hyperthermia secondary to pseudomonas aeruginosa infection. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
Nursing Care Plan 2
Nursing Diagnosis: Risk for Septic Shock
Desired Outcome: The patient with establish normal vital signs, balanced input and output, and usual mentation.
|Assess the patient’s vital signs at least every hour. Increase the intervals between vital signs taking as the patient’s vital signs become stable.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.|
|Start strict input and output monitoring. Measure the urine output hourly.||Decreased urinary output is a sign of diminished renal perfusion, indicating damage to the kidneys due to pseudomonas aeruginosa infection.|
|Assess for changes of level of consciousness/ mentation.||Decreasing level of consciousness indicate diminished cerebral perfusion and/or hypoxemia.|
|Administer intravenous fluid therapy. Administer vasopressors and inotropic agents as prescribed.||To facilitate effective tissue perfusion and maintain circulatory blood volume. To maintain blood pressure level and help improve organ perfusion. Sepsis or septic shock is a complication of P. aeruginosa infection that may manifest as hypotension.|
|Place the patient on bed rest. Assist him/her with important activities of daily living or ADLs.||To decrease myocardial workload and oxygen consumption.|
Nursing Care Plan 3
Nursing Diagnosis: Deficient Knowledge related to diagnosis and need for immediate treatment as evidenced by patient’s verbalization of “How will my infection be treated?”
Desired Outcome: The patient will be able to have sufficient knowledge of pseudomonas aeruginosa infection and its management.
|Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g., mental status and anxiety).||To address the patient’s cognition and mental status towards pseudomonas aeruginosa infection and to help the patient overcome blocks to learning.|
|Explain what pseudomonas aeruginosa infection is, and how it might results to complications that involve the vital organs such as the lungs and heart. Avoid using medical jargons and explain in layman’s terms.||To provide information on the infection and its pathophysiology in the simplest way possible.|
|Educate the patient about antibiotic regimen for pseudomonas aeruginosa infection and the need for isolation.||To give the patient enough information on the treatment protocol for P. aeruginosa infection. Isolation and contact precautions are strongly recommended to prevent the spread of pseudomonas infection.|
|Review proper hand hygiene, overall personal hygiene, and environmental cleanliness.||To lessen the risk of spread pseudomonas infection to other patients or staff.|
|Inform the patient the details about the prescribed medications (e.g., drug class, use, benefits, side effects, and risks) that are being given to treat pseudomonas aeruginosa infection.||To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, and any possible adverse events.|
Other nursing diagnoses:
- Ineffective Breathing Pattern
- Risk for Impaired Gas Exchange
- Impaired Urinary Elimination
- Impaired Skin Integrity
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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